Individual
DR. DARYL L. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
128 ROSS ST, MOLALLA, OR 97038-9390
(503) 829-7677
(503) 829-3398
Mailing address
PO BOX 390, MOLALLA, OR 97038-0390
(503) 829-7677
(503) 829-3398
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6951
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93-1306543
FEIN
OR
01
—
D6951
STATE LICENSE
OR
Enumeration date
01/09/2007
Last updated
08/24/2010
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